Vacuum-assisted Closure and Bilateral Pectoralis Muscle Flaps for Different Stages of Mediastinitis After Cardiac Surgery

Overview

Journal Surg Today

Specialty General Surgery

Date 2009 Nov 3

PMID 19882316

Citations 12

Authors

Zeynep Eyileten

Ahmet Ruchan Akar

Sadik Eryilmaz

Mustafa Sirlak

Levent Yazicioglu

Serkan Durdu

Adnan Uysalel

Umit Ozyurda

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess the results of bilateral pectoralis major muscle flaps (BPMMF) and vacuum-assisted closure (VAC) at different stages of postcardiac surgery mediastinitis.

Methods: Of 65 patients with a deep sternal wound infection (DSWI) after cardiac surgery, 33 with a stable sternum were treated with VAC (59.3 +/- 11.7 years of age) and 32 with an unstable sternum or osteomyelitis (63.3 +/- 9.8 years of age) were treated with early BPMMF and continuous irrigation. Delayed BPMMF reconstruction was necessary in six VAC patients.

Results: The overall incidence of DSWI was 1.04% within the study period. Deep sternal wound infection was diagnosed 15.9 +/- 10.8 days (range 5-62 days) after surgery. Diabetes was more common in the BPMMF group than in the VAC group (P = 0.046). Hospital mortality after treatment was 4.6% (n = 3) overall. Causes of death were septic multiorgan failure and respiratory failure. The infective pathogens were methicillin-resistant Staphylococcus aureus (MRSA; n = 2) and Acinetobacter species (n = 1). The median hospital stay was 29 days (range 15-110 days). After 6 months, only one recurrent sternal infection had occurred in the VAC group.

Conclusions: Early BPMMF is an effective surgical treatment for DSWI in patients with an unstable sternum and osteomyelitis. VAC may be considered for patients without osteomyelitis but a stable sternum, or as adjuvant therapy in patients with comorbidity.

Citing Articles

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[Treatment regimen for deep sternal wound infections after cardiac surgical interventions in an interdisciplinary approach].

Bieler D, Franke A, Vollmecke M, Hentsch S, Markewitz A, Kollig E Unfallchirurgie (Heidelb). 2023; 127(3):211-220.

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Immediate flap increases patient safety for deep sternal wound infection: A meta-analysis.

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Efficacy and safety of pectoralis muscle flap combined rectus abdominis muscle sheath fasciocutaneous flap for reconstruction of sternal infection.

Yu C, Yu C, Yao W, Chen Y, Lee A, Liu Y Int Wound J. 2022; 19(7):1829-1837.

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Vacuum-assisted closure . bilateral pectoralis major muscle flaps for deep sternal wounds infection.

Pan T, Li K, Fan F, Gao Y, Wang D J Thorac Dis. 2020; 12(3):866-875.

PMID: 32274154 PMC: 7139061. DOI: 10.21037/jtd.2019.12.76.

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